Frank's Sign and Risk of Cardiovascular Events in Patients Hospitalized for Pneumonia: A Prospective Single-Center Cohort Study.

Background/Objectives: Frank's sign (FS), an acquired diagonal earlobe crease, has been associated with underlying cardiovascular (CV) disease. Pneumonia, a leading cause of hospitalization, may trigger CV events. FS may help identify patients at increased risk of CV complications following pneumonia. We aimed to evaluate the association between FS and CV events following pneumonia. Methods: We conducted a single-center prospective cohort study of internal medicine patients hospitalized with community-acquired pneumonia at a secondary hospital in Switzerland, followed for 18 months. FS was assessed at inclusion by trained investigators. Baseline characteristics were recorded. The primary outcome was a composite of CV endpoints: new-onset atrial fibrillation/flutter, myocardial infarction, hospitalization for heart failure, peripheral arterial ischemic events, or stroke. Events were identified through hospital records and general practitioner data between 2020 and 2023. Results: Among 203 patients (median age 76.0 years [IQR 65.0 to 83.0]; 41.4% female), 71.2% had FS. During follow-up, 103 CV events occurred. In univariate Cox analysis, FS was associated with an increased hazard of CV events (p = 0.042). After adjustment for confounders, FS was not significantly associated with CV events (HR 0.97; 95% CI 0.59-1.59). Only a history of CV disease and CV risk factors were associated with an increased hazard of subsequent cardiovascular events following pneumonia. Conclusions: In this population of patients hospitalized with pneumonia, Frank's sign was not independently associated with cardiovascular events and appears to reflect underlying cardiovascular risk burden. It should not be interpreted as an independent prognostic marker.